world cancer report - iarc
world cancer report - iarc
world cancer report - iarc
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68%<br />
1955 1975 1995 2025<br />
32%<br />
40%<br />
by at least 62% both for circulatory diseases<br />
and for <strong>cancer</strong>s.<br />
In 2000, there were 6.2 million <strong>cancer</strong><br />
deaths, 10.1 million new cases of <strong>cancer</strong><br />
and 22.4 million persons living with <strong>cancer</strong><br />
<strong>world</strong>wide [6]. This represents a global<br />
increase of about 22% in <strong>cancer</strong> deaths<br />
and in <strong>cancer</strong> incidence during the period<br />
1990-2000. By 2020, the number of new<br />
<strong>cancer</strong> cases is expected to reach at least<br />
15 million a year and <strong>cancer</strong> deaths 10<br />
million a year. WHO in 1998 [5] <strong>report</strong>ed<br />
that in 1960 <strong>cancer</strong> was one of the five<br />
leading health problems in three of the six<br />
WHO regions (The Americas, Europe and<br />
Western Pacific). Moreover, it will be one<br />
of the top five leading health problems by<br />
2025 in all the WHO regions, except for<br />
the Africa region. Cancer is emerging as a<br />
major problem globally, both in more<br />
developed and in less developed countries.<br />
Priority areas for action<br />
Opportunities are clear at national and international<br />
levels for initiatives to control and<br />
reduce incidence, mortality and avoidable<br />
suffering and pain due to <strong>cancer</strong>. With a<br />
better understanding of the causes, mechanisms<br />
and progression of <strong>cancer</strong>, vigorous<br />
implementation of proven interventions, systematic<br />
experimentation and evidence-based<br />
choice of efficient delivery procedures, it is<br />
possible to reduce the burden of <strong>cancer</strong>.<br />
WHO (1998) [5] concludes that by taking<br />
60%<br />
effective action now, <strong>cancer</strong> incidence<br />
can be reduced substantially. Even modest<br />
efforts to adapt and apply available<br />
treatments, early detection methods and<br />
healthy lifestyle approaches will have farreaching<br />
effects on the <strong>cancer</strong> burden<br />
<strong>world</strong>wide. Achieving these goals is predicated<br />
on a commitment to coordinate<br />
global and national priorities for research,<br />
development and implementation of <strong>cancer</strong><br />
control strategies. It requires a broad<br />
focus. In addition to providing evidencebased,<br />
cost-effective clinical interventions<br />
targeting selected <strong>cancer</strong> sites in individual<br />
patients, the task is to deliver essential<br />
yet comprehensive evidence-based, costeffective<br />
medical and health interventions<br />
covering prevention, diagnosis and treatment.<br />
To achieve <strong>cancer</strong> control, a costefficient<br />
approach is required in order to<br />
deliver programmes as a part of the existing<br />
health systems infrastructure (see:<br />
Cancer control package and its delivery,<br />
p323). In some instances, different measures<br />
may be appropriate for the developed<br />
and the developing <strong>world</strong>, but many<br />
aspects of prevention and treatment are<br />
relevant to almost all communities.<br />
Prevention<br />
From a global perspective, <strong>cancer</strong> prevention<br />
can be justifiably focused on three<br />
<strong>cancer</strong>-causing factors: tobacco, diet and<br />
infection. These factors are responsible<br />
for at least 4.6 million <strong>cancer</strong> deaths (73%)<br />
Above 60 years<br />
60 years or less<br />
Fig. 7.14 Worldwide life expectancy at birth is steadily increasing. It is estimated that by 2025, approximately 90% of the total population of all WHO Member<br />
States (representing >90% of the global population) will live for 60 years or more. WHO World Health Report, 1998.<br />
14%<br />
86%<br />
4%<br />
96%<br />
and 7.5 million new <strong>cancer</strong> cases (75%)<br />
annually, and for at least 15.8 million persons<br />
living with <strong>cancer</strong> (72%) in 2000 [8].<br />
Effective promotion of a healthy diet,<br />
smoking avoidance/cessation and safe<br />
sex may be complemented with improved<br />
access to prophylactic and preventive vaccination<br />
and appropriate screening for<br />
high-risk populations.<br />
Infection is responsible for about 17% of<br />
<strong>cancer</strong> incidence <strong>world</strong>wide (varying from<br />
about 7% in developed countries to about<br />
25% in developing countries) [9].<br />
Present knowledge offers means by which<br />
transmission of infectious agents, such as<br />
hepatitis B virus (HBV) and Heliobacter<br />
pylori, can be reduced. Preventive HBV<br />
vaccination is already available <strong>world</strong>wide<br />
and prophylactic vaccination against hepatitis<br />
C virus (HCV) and human papillomaviruses<br />
(HPV) may be introduced in the<br />
near future. The infrastructure for existing<br />
immunization services at national and<br />
international levels could be utilized in this<br />
context.<br />
Early detection<br />
Early detection can lead to a rapid and<br />
complete return to health. Established<br />
methods of screening, whether technology-based<br />
or undertaken by direct inspection,<br />
have reduced the mortality of cervical<br />
<strong>cancer</strong>. HPV testing, when combined<br />
with a conventional cervical smear test,<br />
improves the identification of <strong>cancer</strong>ous<br />
Perspectives and priorities<br />
321